Saudi Arabia reports another MERS-CoV case

Saudi Arabia reported one new MERS-CoV (Middle East respiratory syndrome coronavirus) case today, raising the country's official total to 706 cases.

The latest patient is a 45-year-old expatriate who is hospitalized in Riyadh, the Ministry of Health (MOH) said in today's update. He has no preexisting conditions and is not a healthcare worker. The ministry gave no information about how he was exposed to the virus.

Today's case is only the fourth in the past week, as the rate of reported new infections continues to be far below what it was in April and part of May, when hospital-related outbreaks sparked hundreds of cases. The previous week, Jun 6 to 13, brought nine cases.

With no deaths reported today, the fatality toll in Saudi Arabia remained at 290. Forty patients are still being treated, the MOH says.
Jun 20 Saudi MOH statement
MOH coronavirus page with case count

Multistate Salmonella outbreak tied to feeder rodents declared over

A Salmonella Typhimurium outbreak linked to feeder rodents has grown to 41 cases in 21 states but is now likely over, the Centers for Disease Control and Prevention (CDC) said today in a final outbreak notice.

The total reflects four new cases and three new affected states since the CDC's previous update on May 20. Colorado, Missouri, South Carolina, and Virginia all reported new cases, and the cases were the first for all those states but Missouri, which now has three. California confirmed the most cases: seven.

Illness-onset dates range from Jan 11 to May 17, with patients ranging in age from younger than 1 year to 19 years. Of 37 patients with available information, 6 (16%) were hospitalized. No deaths were reported.

"Epidemiologic, laboratory, and traceback findings linked this outbreak of Salmonella infections to contact with frozen feeder rodents packaged by Reptile Industries, Inc.," the CDC said in its notice.

"Feeder rodents" are those fed to pets such as snakes and birds of prey.

The Food and Drug Administration said to dispose of any Reptile Industries' Arctic Mice brand frozen rodents bought from PetSmart stores from Jan 11 through May 21 by placing the product in a sealed container in the trash, the CDC said. Reptile Industries is based in Naples, Fla.

Earlier this month Canadian officials announced 20 Salmonella Typhimurium cases linked to snakes and feeder rodents. It's not clear whether the two outbreaks are related.
Jun 20 CDC notice
Jun 3 CIDRAP News scan on Canadian outbreak

Study: 7% of deer ticks harbor both Lyme, babesiosis pathogens

Deer ticks (Ixodes scapularis, also called blacklegged ticks) sampled in upstate New York simultaneously harbored the pathogens that cause Lyme disease and babesiosis at almost twice the expected levels, according to a study in PLoS One.

Researchers from the Cary Institute of Ecosystem Studies (CIES) in Millbrook, N.Y., and elsewhere in the United States measured the infection prevalence in 4,368 "questing" nymph ticks (young ticks seeking to feed) that were gathered in the field in Dutchess County, N.Y. They tested for Borrelia burgdorferi, Babesia microti, and Anaplasma phagocytophilum, the pathogens that cause Lyme disease, babesiosis, and human granulocytic anaplasmosis, respectively.

The investigators found that almost 30% of the questing nymphs were infected with B burgdorferi, and a third of those were also infected with at least one other pathogen.

Specifically, 6.7% of the questing nymphs (292) were infected by both B burgdorferi and B microti, a rate 83% higher than would be predicted by chance alone. Infections with all three pathogens occurred in only 0.52% of ticks, and co-infection of A phagocytophilum with either of the other two pathogens was also low (0.53% and 2.4%).

"People in tick-infested parts of the United States, such as the Northeast, Mid-Atlantic, and Upper Midwest, are vulnerable to being exposed to two or three diseases from a single tick bite," said senior author Felicia Keesing, PhD, in a CIES press release. "And, of course, that risk increases when they're bitten by more than one tick."
Jun 18 PLoS One study
Jun 19 CIES press release

Meta-analysis shows benefits of antibiotics for cholera

Antimicrobial drugs substantially improve clinical and microbiologic outcomes in patients with cholera, according to a meta-analysis published yesterday in the Cochrane Library.

The research team, based at Liverpool School of Tropical Medicine (LSTM), reviewed 39 randomized and quasi-randomized controlled clinical trials that encompassed 4,623 patients, both adults and children.

From a clinical perspective, the drugs shortened diarrhea episodes by a day and a half compared with placebo or no treatment. Antimicrobial treatment also halved stool volume, cut the amount of rehydration fluid by 40%, and shortened the duration of fecal bacteria extraction by nearly 3 days.

Researchers found variation in the size of the antibiotic benefits, which they said probably related to differences in antibiotics, trial methods, and outcome assessments. They noted, though, that benefits were seen across a range of disease severity.

No obvious differences stood out in drug head-to-head comparisons, but indirect comparisons seemed to show tetracycline had greater benefits than doxycycline, norfloxacin, and trimethoprim-sulfamethoxazole, and single-dose azithromycin shortened diarrhea by a day when compared with ciprofloxacin and by a half day when compared with erythromycin.

Lead author Ya'ara Leibovici-Weissman from Tel Aviv University said in an LSTM press release that, for Vibrio cholerae infections, quick and accurate diagnosis is key, but the results of the study show antibiotics yield substantial improvements. "Our results also point to the likelihood that azithromycin and tetracycline may have some advantages over other antibiotics."
Jun 19 Cochrane Library abstract
Jun 19 LSTM press release